Therapeutic Interventions

Natalie is experienced in utilizing the following evidence-based treatment interventions:

Cognitive Behavioral Therapy (CBT)

CBT is used to treat a variety of disorders including OCD, OCD related disorders, anxiety, and depression. Because our thoughts and feelings cannot be controlled it is important for treatment to focus on behavior modification. As behaviors become more adaptive and consistent with one’s goals and values, their thoughts and feelings begin to change accordingly (i.e. rational thought and less anxiety or fear). Cognitive restructuring is another component of CBT. This approach is used to adjust maladaptive thoughts that only reinforce the disorder. One way to modify thought over time is to identify evidence that may support or refute a maladaptive thought. The ability to recognize when thoughts may not be supported by realistic evidence can help one not allow their thoughts to dictate their behaviors. For example, if one has a fear of dogs, they may think that all dogs are dangerous or bad (cognitions), feel anxiety or fear when near a dog (affect), and ultimately avoid all dogs (behavior). CBT therapy would have one gradually experience situations or objects related to dogs and overtime, thoughts might begin to change to the extent that one might not think all dogs are dangerous, and ultimately reducing anxiety.

Exposure and Response Prevention (ERP)

ERP is a type of CBT that focuses on behavior modification. ERP is an empirically supported therapeutic approach in the treatment of OCD, related disorders, and anxiety disorders. Clients begin by completing a thorough hierarchy, a tool which a client uses to rate their level of perceived anxiety for various situations/objects/images/thoughts related to their fear. Each behavior to purposely engage in the triggering situation, object, image, or thought rated in a hierarchy is called an exposure. ERP involves gradual exposures while refraining from performing compulsions. The more a client confronts their triggers, the sooner they habituate to it, meaning an elimination of anxiety and compulsive urges.

Habit Reversal Training (HRT)

HRT is used to treat Tourettes, Tic Disorder, Trichotillomania and Excoriation. The first step of HRT is awareness training followed by client’s using a competing response (a behavior that is appropriate and adaptive) to replace the target behavior until the urge to complete the target behavior subsides.

Behavior Activation

Depression is commonly treated with behavior activation, a behavior approach that allows clients to re-engage in their lives and relationships. Clients complete a hierarchy of reinforcing behaviors that are rated based on difficulty. As the client reengages in behaviors that were previously enjoyed, depressive symptoms subside. Clients are instructed to complete the reinforcing behaviors regardless of motivation at the time.

Assertiveness Training

A common symptom associated with OCD and anxiety disorders is a client’s tendency to be passive and unable to make decisions. With pervasive passivity comes lack of confidence and reduced self-esteem. The first step of assertiveness training is learning to distinguish between passive, assertive, and aggressive behaviors. This is followed by the client examining how they have responded to a specific conflict and then determining how they could have behaved more assertively. As assertive behaviors are actively practiced, clients eventually behave more confidently within personal and professional relationships.